Winnie Mading writes about moms who choose to feed breastmilk via bottles instead of at the breast. She has a very good point-the importance of supporting moms' choices. When I have been working with a mom who has been pumping because baby is either not latching or not transfering milk well, and she begins to talk about it being easier to feed the baby pumped breastmilk, I give her "my talk". I acknowledge the difficulty she is having and affirm that, yes, in the short term, it might seem easier to pump and bottle feed. I tell her that it is certainly an option, however, I want her to be able to make an informed choice and what choosing this option is likely to entail. I tell her that for starters, it is twice the work to feed this way. Then I discuss the difficulty of being diligent enough to pump as frequently as is needed to keep up her milk supply. And, that my experience in working with moms who choose this route, the majority find that by 3-4 months of age it is too demanding on their time and they then switch to formula. (not all, but most) I tell them that it is their choice, as long as they are aware of the consequences of their choice. I also discuss the bonding aspects of feeding at the breast. If they then decide to continue on with their plan to pump and bottle feed (which most do) then I give them information to make it as successful as possible. This includes Ameda's handout on "How to establish a full milk supply with a breast pump" and a web site that is for moms exclusively pumping and feeding by bottle. One last thing I always mention to them, is if they choose pumping and bottle feeding, and then find they can't keep up, they need to remember that they can continue pumping as much as they can, and use what breastmilk they get-that it is not an all or none thing. I actually had a mom reply after telling her that, "You mean I can do that? Give both breastmilk and formula?" I always reinforce that the benefits of breastfeeding are dose related (more=better), however ANY amount of breast milk makes a difference and to give what they can-if the choice is between all artificial milk or artificial milk and some breastmilk to do the latter. I have to remind myself sometimes that it is their baby and their choice-I can provide information and support, but I am not the one doing the work. 

Warm regards-
Stacy D. Kucharczk, MSN, RN, CPNP, IBCLC
Virginia Beach

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